the Trauma Assessment process

I’ve been participating in a trauma assessment (which I initially wrote as a therapy assessment LOL) for the last few weeks. I described how felt when I first got the call from the intake person in this post. I ended up scheduling four 90 minute meetings with the intake worker. So far I’ve been to three of them. I’ve spent hours filling out forms trying to describe to what degree I agree or disagree with a variety of statements about my feelings, symptoms, goals, etc. I’ve described the medications I’ve tried, the episodes of depression, my family history. There was a questionnaire that listed about 30 different types of traumatic events that a person might have experienced and asked if it happened to me, at what age(s), how it effected me at the time and in my present life. There was even a client-therapist working alliance inventory. I struggle with questionnaires. I find that the questions are ambiguous and therefore need clarification.

I started in the very first session by describing my doubts about therapy and my relationship with M. That session meandered around the things that have improved in the last 4.5 years and the areas of my life that are stuck. The second session was a more general background talk about my family history, medical history, etc. Last week’s session was a recitation of the traumatic events of my life. It was exhausting and so triggering. I haven’t slept well on the nights after these sessions. It feels like some warped “greatest hits” version of my life is replaying in my mind. I remember more things after we talk, not things that I never knew but more things that I remember but I haven’t thought about in so long that it seems like they have just burst back into my consciousness and I have to turn them over and over to get used to them again. I also realized that some types of traumatic events had occurred but when I filled out the forms a couple of weeks ago I said no they hadn’t quite honestly. It was M who pointed them out to me during my session last week. I think I am so focussed on my childhood that I dismiss some of the events that have happened to me as an adult so I didn’t think of them. Of course the questionnaire didn’t say were you ever in a life threatening accident as a child as an example so I might have to go back this week and admit to a few more traumatic events.

I think the anxiety around the assessment has made a lot of things more difficult this month. I am sure it contributed to my recent confusing communications with M and my fear that he was getting tired of working with me. The voice of despair that lives in my head has been a lot louder over the last few weeks. It keeps asking me why I am doing the assessment? what could possibly come out of it? if I could have helped I would have been already? some things are unfixeable… and on and on and on. I promised myself I would finish the process and try to be as honest as possible even if I felt like it was useless so I’m trying to let the thoughts be and not engage in the discussion about whether it will be helpful or not. Unfortunately the sessions with the intake worker are over this week and then I have to meet with the doctor. As today as progressed I have felt physically sick. It started with a scratchy throat which I developed into soreness. I feel slightly feverish and incredibly tired. I get a cold anytime I am too stressed. Before I started therapy I used to get an average of six to eight colds a year which would last for a week and be severe enough that I had to take time off work (I know because I counted them to talk to my doctor about it). I think being sick was the only time I allowed myself to stop running around and doing everything I was “supposed” to do. I have learned to take care of myself and slow down before I was sick over the last few years and so this is the first time I have been sick in a while.

I feel like I am going to throw up

There has been so much happening in the last two weeks and my emotions have been swinging wildly that I haven’t been able to write at all. I start a post in my head and by the time I sit down at the computer I feel so differently that I can’t write it. I have been having productive, relatively easy (to talk anyway) sessions with M up until friday. Friday’s session was so awful that I left feeling like I had broken into a million pieces and my thoughts kept flitting to a different piece over and over. I couldn’t describe anything that I was feeling. Afterwards I left a voice message expressing my sadness and I can’t remember what I said. Later I sent an email which was angry and confusing (at least when I reread it now). Actually I can’t finish reading either my email or his response to me because I am overwhelmed with needing to stop reading and do something else. I can’t remember what I was so upset about or what he was saying during my session anymore. I could have listened to my recording but I was too afraid of what I would hear. Instead I am supposed to go to my session in about three hours which makes me sick to my stomach.

Change

I’ve had three sessions with M since the holiday break. The first one I talked about Christmas and some of the funny moments as well as touching on the difficult ones. During the second I managed to talk honestly about my marriage. I’ve touched on the problems I am having in my relationship with my husband but briefly and in little detail. In the past when I’ve talked about it with M I felt that he supported my husband and thought that the problems we had were caused by me. So sessions about my marriage usually started with me talking about a disagreement or an issue I had with my husband and then no matter what M said; if he asked a question or reflected back my feelings, or looked concerned, I would think he blames me and start to shut down. M would ask me more questions and I feel like he was trying to corner me so I would stop answering. Then sometime after the session I would email him and say I felt like you were blaming me when you said …. and he would reply and explain what he meant or expand on what he was thinking. This happened over and over.

Last week I spoke for the entire session telling M stories from the last three months. I told him about fights we had and things I had said. I talked about my frustration and my fear that my marriage was only getting worse the more I tried to express my feelings and share myself with my husband. He didn’t have very much time to respond because I talked so much which is very unusual. After the session I started to worry that I hadn’t given a very balanced description of things to M. I had blamed my husband too much and not acknowledged the fact that I can be a bitch sometimes. Interestingly I didn’t worry that M thought things were my fault. I couldn’t recall one word or look or pause that suggested that M blamed me. I was surprised.

When I went to my session on Monday we started by discussing the suggestion M had made a few months ago that my husband and I meet with M to do some couple therapy. M told me that after hearing me talk more about the issues and hearing me discuss the strategies I had used in my discussions with my husband and things hadn’t improved he wasn’t sure that meeting with him would be helpful. He thought that perhaps it might be better for my husband and I to see a different therapist who could help us work through things. He asked me questions about whether there was a time in our relationship when we had been able to communicate more effectively? when he wasn’t so reactive? what marriage therapy in the past was like? was my husband able to talk about his feelings with the marriage therapist? at home after sessions? etc. I can’t say that I didn’t have thoughts cross my mind like he doesn’t want to work with us because he thinks we are irreparable or he is asking if my husband talked about his feelings differently with a therapist than when alone with me because he thinks I”m uncaring or self-absorbed and didn’t ask but I didn’t get caught up in those thoughts. I didn’t leave his office replaying the session in my mind until it seemed to prove that M was blaming me. I had no urgent need to email M to clarify what he meant when he said …

I know it probably doesn’t seem like a very big deal to have three sessions with your therapist that don’t result in a minor crisis of feeling like your therapist blames you for your problems, or doesn’t like you, or thinking of quitting therapy but I think this might be the longest I have gone in 4.5 years of therapy without a minor crisis. I am not anxious about my session tomorrow. I am not worried that it will be my last session or something unexpected will explode and ruin my relationship with him. It feels different. It has changed. I guess it is probably too much to hope that it will last but I had to write it down now while I felt it. I think M is trying to help me and he isn’t trying to get away from me, no I don’t just think it I BELIEVE it.